Consumer Reports: Back to Basics for Safer Childbirth

When it’s time to bring a new baby into the world, there’s a lot to be said for letting nature take the lead. The normal, hormone-driven changes in the body that naturally occur during delivery can optimize infant health and encourage the easy establishment and continuation of breastfeeding and mother-baby attachment. Childbirth without technical intervention can succeed in leading to a good outcome for mother and child, according to a new report. (Take our maternity-care quiz to test your knowledge.)

“Evidence-Based Maternity Care: What It Is and What It Can Achieve,” co-authored by Carol Sakala and Maureen P. Corry of the nonprofit Childbirth Connection analyzed hundreds of the most recent studies and systematic reviews of maternity care. The 70-page report was issued collaboratively by Childbirth Connection, the Reforming States Group (a voluntary association of state-level health policymakers), and Milbank Memorial Fund, and released on Oct. 8, 2008.
OVERUSE OF HIGH-TECH MEASURES

The report found that, in the U.S., too many healthy women with low-risk pregnancies are being routinely subjected to high-tech or invasive interventions that should be reserved for higher-risk pregnancies. Such measures include:

Inducing labor. The percentage of women whose labor was induced more than doubled between 1990 and 2005

Use of epidural painkillers, which might cause adverse effects, including rapid fetal heart rate and poor performance on newborn assessment tests
Delivery by Caesarean section, which is estimated to account for one-third of all U.S births in 2008, will far exceed the World Health Organization’s recommended national rate of 5 to 10 percent
Electronic fetal monitoring, unnecessarily adding to delivery costs
Rupturing membranes (”breaking the waters”), intending to hasten onset of labor

Episiotomy, which is often unnecessary

In fact, the current style of maternity care is so procedure-intensive that 6 of the 15 most common hospital procedures used in the entire U.S. are related to childbirth. Although most childbearing women in this country are healthy and at low risk for childbirth complications, national surveys reveal that essentially all women who give
birth in U.S. hospitals have high rates of use of complex interventions, with risks of adverse effects.

The reasons for this overuse might have more to do with profit and liability issues than with optimal care, the report points out. Hospitals and care providers can increase their insurance reimbursements by administering costly high-tech interventions rather than just watching, waiting, and shepherding the natural process of childbirth.

Convenience for health care workers and patients might be another factor. Naturally occurring labor is not limited to typical working hours. Evidence also shows that a disproportionate amount of tech-driven interventions like Caesarean sections occur during weekday “business hours,” rather than at night, on weekends, or on holidays.

UNDERUSE OF HIGH-TOUCH, NONINVASIVE MEASURES

Many practices that have been proven effective and do little to no harm are underused in today’s maternity care for healthy low-risk women. They include:

Prenatal vitamins
Use of midwife or family physician
Continuous presence of a companion for the mother during labor
Upright and side-lying positions during labor and delivery, which are associated with less severe pain than lying down on one’s back
Vaginal birth (VBAC) for most women who have had a previous Caesarean section
Early mother-baby skin-to-skin contact
The study suggests that those and other low-cost, beneficial practices are not routinely practiced for several reasons, including limited scope for economic gain, lack of national standards to measure providers’ performance, and a medical tradition that doesn’t prioritize the measurement of adverse effects, or take them into account.

February 24th, 2009 at 11:09 pm edit
Isis says:
Thanks for posting this its about time the rest of the media caught up to this.

February 26th, 2009 at 9:39 am edit
rachel moses says:
it is so great to see this issue of mistreatment of birth being addressed in the mainstream media. having had 2 home births myself, i am totally horrified disgusted by the invasive abusive treatment i see most of the women around me receiving at their hospital births. lets get this straightened out ladies! walking through the doors of a hospital as a pregnant woman put you/baby way too much danger. drugged up moms and newborns and 30+% c-section rate? come on, this is just not acceptable. Also in serious question ought to be all this “scanning” of babies in the womb; just 30 years ago x-rays were supposdly safe and we now know of course taht they are not. How about the pathetically low (1%) of babies who are breastfed to the World Health Organzation’s reccommended TWO FULL YEARS. And further, what is up with all this machine milking women to bottle feed babies with? its disgusting, and even the La Leche league organization seems to accept it as an equivalent when it clearly is NOT. It negates all of the importance of the MOTHER being with the baby. What no one is talking about either are the far reaching effects. lets hear more about these issues!

February 27th, 2009 at 1:22 am edit
Kate Quick says:
Machine milking women to bottle feed babies? Well, if women who want to breastfeed don’t hook themselves up to machines, they have three options. 1)Take their babies to work with them, which most employers won’t allow and which probably isn’t that feasible once babies can crawl, at least not without a playpen, which is a whole different argument. 2) Take a much much longer maternity leave than any employer I’ve ever heard of will pay for or even grant unpaid. 3) Stay at home with her babes. It all comes down to economics and misplaced priorities. The same is true of maternity care…economics and mislplaced priorities. It’s time to reprioritize. Let’s put moms and babes first, for a change. Longer maternity leaves for working women, respect for midwives and women who use them, and a little more anger at the mistreatment of women birthing in a hospital setting. Oh yeah, and a little more faith in our bodies’ ability to give birth!

Look into Reflexology to safely and gently assist in increasing cm. Consult with a qualified Reflexologist in your area or close. You may contact me on this site or my office, should you have further questions.

They talk about it some on bobb, and do not have good things to say about. If you haven't seen it, you should. I wouldn't recommend using that. There are so many other options, I would try everything else before even considering it.

I am 41 weeks today and was at midwife today. She suggested waiting till later in the week and then possibly, and if i am comfortable with it, taking misoprostyl. Has anyone else taken this and if so what was their opinion of it? Also any advise on how to get things going? I am still at 1 cm. I would appreciate any help! Thanks!

My baby boy turn 1 year old on Monday. I just can't believe how fast the year flew by and how big he's gotten. I'm already thinking about having another but I probably wont for at least a year or 2. So I know it's a year late but I posted my birth story on a blog. So if you're interested go check it out. It is long but, it's Levi's story. Thanks and Good Luck to all you preggos. Hope you all get the best birth for you!

Hi I am expecting our 3rd and due in approx 2 weeks. My baby is currently posterior and baby just recently dropped. Is there anything i can do to get the baby to turn around or is it too late since baby already dropped? I would appreciate any help. Thanks!

To both mommies who are having difficulty relaxing. Purchase Deepak Chopra's pregnancy and childbirth book. It focuses on the normalcy of pregnancy and birth along with Ina May's guide to childbirth. Pregnancy and birth have been around since before any of us were able to see horror stories on TV. Women do and can experience happy healthy pregnancies with good support and resources. Surround yourself with women who have had positive pregnancy and birth experiences. You will be fine.

Hi all. I am pergnant with our second child, and we are due in July. Our first pregnancy was easy, I had a wonderful midwife and I think that helped alot. This time I am at a military care facility, and I have not seen the same doctor twice, and I am planning to deliver in a hospital.

I thought the second pregnancy would be easier since I already know what to expect, but it hasnt been. The baby and I have been healthy, but I am having alot of anxiety. Anxiety about the pregnancy, the delivery (the last one didnt go well), the postpartum care, being able to breastfeed, having another long labor, or having a very short labor and not making it to the hospital (which is 2 hours away).

I have had alot of touble sleeping, because I am awake with all of these anxious thoughts.

We are living 4000 miles away form our family and freinds and I think not having that support is part of the problem.